Roberta'S Lovely Ladies Boutique

Primary specialty

Mastectomy FitterTaxonomy code 224900000X

Legal business name

ROBERTA'S LOVELY LADIES BOUTIQUE

Practice address

603 W. Delmar
Alton, IL 62002

Phone

(618) 467-0640

NPI assigned

Mar 4, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Carol A LoganNPI 1417318197

Title

Owner

Phone

(618) 467-0095

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Carol Logan

  • Durable Medical Equipment & Medical Supplies
  • Alton, IL
  • NPI 1417318197
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1457049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457049600000",
    "number": "1174983050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 W. DELMAR",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "62002",
            "telephone_number": "618-467-0640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 W. DELMAR",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "62002",
            "telephone_number": "618-467-0640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERTA'S LOVELY LADIES BOUTIQUE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-04",
        "last_updated": "2016-03-04",
        "status": "A",
        "authorized_official_last_name": "LOGAN",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-467-0095",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "224900000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Mastectomy Fitter",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Riverbend Head Start & Family Services
• Riverbend Head Start & Family Services
• Riverbend Head Start & Family Services
• Miranda Walker Robbins, LCSW
• Regina Robeen, ASN,RN
• Robertas Lovely Ladies Boutique
• Bradley Wane Roberts, D.M.D.
• Kevin Brent Roberts, P.T.
• Sara B Roberts, RPH
• Janis M. Robinson, MD

• Mastectomy Fitter in Alton, IL
• Providers in Alton, IL by specialty
• Mastectomy Fitter in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.